P Rospective D Etermination of M Edical N Ecessity for a Mbulance T Ransport by P Aramedics

Gratton, Matthew; Ellison, Stefanie R.; Hunt, Jason; John, Oommen

doi:10.1080/31270300220x

Cited by 67 publications

(33 citation statements)

References 8 publications

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“…39 In 2001, Pointer et al 40 reported paramedic determinations about medical necessity in Alameda County, California, when using a set of written guidelines, and found that 113 of the 1,180 patients in the data set (9.6%) had been undertriaged based on a reference standard of physician determination that the patient should be transported directly to the emergency department (ED). In 2003, Gratton et al 41 reported paramedic determinations of medical necessity in Kansas City, Missouri, where paramedics used a structured, five-item screening form. All patients were transported to an ED where the emergency physician, blinded to the EMS provider's evaluation, completed the same screening form.…”

Section: Ems Determinations Of Medical Necessity For Ambulance Transportmentioning

confidence: 99%

“…The study authors note that the EMS providers undertriaged 11% of patients, although it is unclear how it was determined that a patient was undertriaged. 41 Of note, both the Pointer and Gratton studies compared EMS providers with an emergency physician "gold standard" rather than examining actual patient outcomes. Therefore, it is possible that the assessment by the emergency physicians would have resulted in overtriage rather than the EMS providers' assessments' resulting in undertriage.…”

Section: Ems Determinations Of Medical Necessity For Ambulance Transportmentioning

confidence: 99%

See 1 more Smart Citation

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

Millin

Brown²,

Schwartz

2011

Prehospital Emergency Care

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With increasing demands for emergency medical services (EMS), many EMS jurisdictions are utilizing EMS providerinitiated nontransport policies as a method to offload potentially nonemergent patients from the EMS system. EMS provider determination of medical necessity, resulting in nontransport of patients, has the potential to avert unnecessary emergency department visits. However, EMS systems that utilize these policies must have additional education for the providers, a quality improvement process, and active physician oversight. In addition, EMS provider determination of nontransport for a specific situation should be supported by evidence in the peer-reviewed literature that the practice is safe. Further, EMS systems that do not utilize these programs should not be financially penalized. Payment for EMS services should be based on the prudent layperson standard. EMS systems that do utilize nontransport policies should be appropriately reimbursed, as this represents potential cost savings to the health care system.

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Section: Ems Determinations Of Medical Necessity For Ambulance Transportmentioning

confidence: 99%

Section: Ems Determinations Of Medical Necessity For Ambulance Transportmentioning

confidence: 99%

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

Millin

Brown²,

Schwartz

2011

Prehospital Emergency Care

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“…[12,13] On the other hand, it has been estimated that 11%-61% of the transports are medically not necessary. [14] Typical reasons for non-conveyance seem to include refusal to travel, minor or no injuries, recovery after treatment on scene, falls in elderly people or a visit by the patient's general practitioner. Sometimes family members decide to arrange their own transport.…”

Section: Introductionmentioning

confidence: 99%

Non-conveyance of patients: Challenges to decision-making in emergency care

Leikkola¹,

Mikkola²,

Salminen‐Tuomaala

et al. 2016

Clinical Nursing Studies

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Background: It has been suggested that emergency care providers' decision-making competence should be strengthened regarding whether or not to transport the patient. This qualitative study describes challenges related to non-conveyance situations from emergency care providers' perspective. Methods: Data were collected by a questionnaire from emergency care providers of a hospital district in Finland in 2014. Responses to open questions were analyzed using inductive content analysis to examine the difficulty of non-conveyance decisions, reasons for non-conveyance and challenges related to the non-conveyance decision after immediate care. Results: The majority (70%) of care providers did not experienced difficulty in making non-conveyance decisions, although those working in basic emergence care found decision-making slightly more challenging than workers in advanced emergency care. Care providers' reasons for not transporting patients were most commonly connected with their assessment of care needs and the conclusion that no hospital care was required. Other reasons involved treating the patient on site, psychosocial reasons and not seeing the patient as an emergency care client. Difficulty of reaching mutual understanding with patients was considered the greatest challenge. Other challenges included worrying about the patient's coping at home and problems in inter-professional co-operation, related to hurry and the concern that doctors did not always document requests for care instructions. Conclusions: The results suggest that care providers' skills in assessing care needs and making decisions based on assessments are a decisive factor in non-conveyance situations. Reaching a mutual understanding with the patient is the greatest challenge.

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“…28 Additional research has shown that 11-61 percent of patients transported by ambulance to EDs could have been safely treated elsewhere. [29][30][31][32][33] Under current policies for reimbursing EMS agencies, however, ambulances are reimbursed only if they provide transportation to the ED. Thus, EMS agencies have no financial incentive to offer patients alternative destination options, even if doing so would provide a more patient-centered and cost-sensitive approach.…”

Section: Of Ed Visitsmentioning

confidence: 99%

The US Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready For Disasters

Lurie¹,

Margolis²,

Rising

2013

Health Affairs

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The emergency care system is an essential part of the US health care system. In addition to providing acute resuscitation and life-and limb-saving care, the emergency care system provides considerable support to physicians outside the emergency department and serves as an important safety-net provider. In times of disaster, the emergency care system must be able to surge rapidly to accommodate a massive influx of patients, sometimes with little or no notice. Extreme daily demands on the system can promote innovations and adaptations that are invaluable in responding to disasters. However, excessive and inappropriate utilization is wasteful and can diminish "surge capacity" when it is most needed. Certain features of the US health care system have imposed strains on the emergency care system. We explore policy issues related to moving toward an emergency care system that can more effectively meet both individuals' needs for acute care and the broader needs of the community in times of disaster. Strategies for the redesign of the emergency care system must include the active engagement of both patients and the community and a close look at how to align incentives to reward quality and efficiency throughout the health care system.

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P Rospective D Etermination of M Edical N Ecessity for a Mbulance T Ransport by P Aramedics

Abstract: Paramedics and emergency physicians agreed that a significant percentage of patients did not require ambulance transport to the emergency department. Despite only moderate agreement regarding which patients needed transport, the undertriage rate was low.

Cited by 67 publications

References 8 publications

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

Non-conveyance of patients: Challenges to decision-making in emergency care

The US Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready For Disasters

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